Redefining Tenure at Medical Schools

It's a common field on application forms for medical research grants, says Maryrose Franko, senior program officer at the Howard Hughes Medical Institute (HHMI). In many cases, "no" means disqualification. But a few years ago, HHMI noticed that more and more top applicants for their early-career award were not tenure-track. "There were so many people who weren't tenure-track yet who were exactly who we wanted to support," Franko says. So, last year, they decided to expand the award's tenure-track requirement. Now, they also accept applicants who don't have the tenure-track label but can prove an equivalent level of institutional support. HHMI's decision followed on the heels of a similar one made by the Burroughs Wellcome Fund (BWF) for its translational research award. "Our guidelines did say you have to have a tenure-track position," says Nancy Sung, a senior program officer. "And now we say tenure-track or equivalent."

Those changes reflect a shift in the role of tenure in academic medical institutions. Traditional tenured and tenure-track research positions are still common, but they are becoming a smaller proportion of the total medical school faculty. These days, new faculty members are increasingly likely to be hired in nontenure-track positions, a better match for the short-term grant funding the institutions rely on. And many of those who do manage to land a coveted tenure-track position face reduced financial guarantees and a challenging funding environment.

As a result, today's early-career job seekers in academic medicine must look beyond the tenure-track label and look closely at the details: a position's specific financial guarantees, the institution's commitment to its nontenured young researchers, the value of the experience they will gain, and the contribution they will make to society. And while checking the nontenure-track box used to imply a tremendous disadvantage on grant and job applications, the gap seems to have narrowed. "What does tenure mean anymore?" Franko asks.

Shifting choices for Ph.D.s

Courtesy, Andrea Ladd

Andrea Ladd

What, indeed? Medical faculties are roughly divided into two parts: clinical faculty members who hold M.D.s or dual degrees and basic-science faculty members who hold Ph.D.s. Many medical schools offer tenure to only their basic-science faculty--an attempt to be consistent with the benefits offered to Ph.D.s throughout the university. But some medical centers are not part of a university and so don't offer tenure to anyone.

The relative decline of tenure at medical schools is largely a result of the rapid expansion in the numbers of clinical faculty being hired, usually, but not always, without tenure; the proportion of tenured and tenure-eligible faculty declined even as their numbers increased, according to a 2007 article in Academic Medicineby Sarah Bunton and William Mallon of the Association of American Medical Colleges (AAMC) in Washington, D.C. But a similar, though less dramatic, trend has also affected nonclinical faculty. Over the same period, the percentage of Ph.D. basic-science faculty with tenure or on the tenure track fell from 83% to 76%--right in line with the numbers from nonmedical college and university departments.

These trends can lead to difficult choices for Ph.D.-holding job candidates familiar with the traditional tenure model. When Andrea Ladd, who has a Ph.D. in cell biology and anatomy, did her first faculty job search in 2004, one of her top choices was the Cleveland Clinic: It's strong in both heart disease and RNA biology, and her research is at the intersection of those two fields. "It's a really great fit for my science," she says. She also found the atmosphere congenial and collaborative. But the Cleveland Clinic did not offer tenure, whereas some of her other choices did. She had always envisioned herself in a tenure-track position, but she started to wonder whether tenure was important after all.

"It's not true that tenure equals support," Roy Silverstein, chair of Cleveland Clinic's Department of Cell Biology, tells recruits like Ladd. "What the clinic has done is develop a series of systems, processes, and benefits which turn out to be more important than tenure." That includes in-depth coaching and mentoring programs, as well as bridge funding to carry people through rough periods. They also have an up-or-out review that resembles the tenure review, which helped convince Ladd that her colleagues would be of the same--or higher--caliber as those at an institution that offers tenure.

Ultimately, Ladd agreed with advice her postdoc adviser gave her: "What I really need to look at, more than whether or not there's tenure, is what the environment's going to be like," she says. More than 3 years later, now assistant staff (the equivalent of assistant professor in other institutions) in the cell biology department at the Cleveland Clinic, she's pleased with her choice. "Not having tenure means everybody has to stay productive and keep working really hard, and it keeps the whole environment really competitive," Ladd says.

Tweaking the tenure clock

Courtesy, Steven Wendell

Steven Wendell

Even at medical schools with tenure, institutions' increasing flexibility has given scientists the freedom to opt for unconventional paths.As a postdoc, Steven Wendell, who has a Ph.D. in genetics, had become active in the National Postdoctoral Association, at which he discovered a love for science policy and administration. So for his first faculty position at the University of Pittsburgh, he split his time between administrative responsibilities in the career development office of the Schools of the Health Sciences and research responsibilities in the School of Dental Medicine, where he was a rare Ph.D. among physician-scientists.

Although he ultimately wanted tenure, he did not want his first few years in this unusual arrangement to count because his research accomplishments would be limited. A dual role is "not optimal for making progress on your tenure," he says, but "it was enormously fulfilling." So his supervisors agreed that he would spend the first several years in a nontenure-track position and then transition to a tenure-track position, which he is doing now. That means giving up his administrative responsibilities and focusing on research and teaching. "Pitt's very good at developing from within and very supportive of people in that category of nontenure-track," he says.

Physician-scientist Tony Moody, an instructor at Duke University School of Medicine, is also on the cusp of a track switch. After finishing his bachelor's degree at Duke, Moody worked for several years as a chemist, eventually joining the laboratory of Duke HIV researcher Barton Haynes. Moody then decided to attend medical school, again at Duke, so he could run his own laboratory. After Moody finished his training, Haynes recruited him again to join the newly created Center for HIV/AIDS Vaccine Immunology at Duke, where Moody now runs his own lab. He spends 90% of his time in his cellular immunology lab and the rest treating patients.

Like Wendell, Moody negotiated a nontenure-track position followed by a transition to a tenure-track position when he felt ready. "Getting independent grants right now is so tough that making that jump ... didn't seem to be a particularly wise move," Moody says. To make grant-writing easier for people off the tenure track, Duke's medical school recently changed the nomenclature of its faculty tracks, moving from coded names such as associate clinical professor to a more neutral numbering system, such as Track V professor. Both titles denote nontenure-track status. The medical school's administration hopes this will combat the prejudices of the grant reviewers, as well as help do away with the "class system" common at many medical schools, says Ann Brown, the associate vice dean for faculty development at the medical school.

Now on the cusp of his transition to the tenure track, Moody is optimistic about his chances of success at earning tenure, but circumspect. "Tenure isn't necessarily the only goal," he says. He wonders whether "the extra 10, 15, 20 hours a week worth of work" required to get tenure might be better spent with his family. "If I succeed and get tenure at Duke--great," he says. "And if I don't, then there certainly are other opportunities out there."

Changing money

Courtesy, Jayanta Debnath

Jayanta Debnath

Moody notes that even with tenure, "you're guaranteed a job, but you're not necessarily guaranteed a great salary." The way his contract works, he'll get only about 25% of his salary if he fails to secure any grant funding. And he might even be considered lucky: In the 2007 Academic Medicine article, Bunton and Mallon reported that 38% of medical schools offered no financial guarantee for tenured clinical faculty and 35% offered no financial guarantee for tenured basic-science faculty.

Jayanta Debnath, a physician-scientist, found a similar situation during his job search a few years ago; he interviewed for one tenure-track position that guaranteed 100% of his salary, but another offered no salary guarantee at all. That played only a small part in his decision, he says; a supportive working environment was more important. "I knew I was going to either have to get a NIH-funded grant between year 3 and year 5 or I was going to have to look for some other type of employment." Debnath is now an assistant professor in the Department of Pathology at the University of California, San Francisco, where 50% of his salary is guaranteed.

Like many, Debnath's tenure-track position came with protected research time, meaning that the university covered his expenses until he could get National Institutes of Health (NIH) funding, which he recently secured. (NIH's research grant eligibility requirements have long been "tenure-track or equivalent," the term BWF and HHMI recently adopted.) "I'm one of the lucky few," he says, noting that most nontenure-track physician-scientists have neither salary guarantees nor protected time. They are expected to bring in enough money right away to both pay their own salaries and support their labs--either by seeing patients or by getting grants.

With patients abundant and grants elusive, Debnath has seen many physician-scientist colleagues forced to let their research lapse in favor of more lucrative--and often more urgent--clinical duties. "For these soft-money positions, you fund your own salary to the expense of your own lab," he says. He notes that physicians with more intensive specialties, such as neurosurgery or emergency medicine, were more likely to be overwhelmed by those duties than others. "I don't know of a single person who has succeeded" in getting a high-level research grant without a tenure-track or similarly protected position, he says.

New definitions

Tenure-system changes are happening for two reasons, says Bunton, who is a senior research analyst at AAMC. First, medical schools operate on a "tenuous" funding model that does not mesh well with the permanent commitment they make to their tenured faculty. Second, schools are recognizing that the increasing research and funding pressures of a traditional tenure-track pathway are sometimes unrealistic in the face of patient care, teaching, or--for some--family responsibilities outside of work.

Nonetheless, Bunton's research suggests that the tenure system is not in danger of disappearance. Since at least 1994, when AAMC began its surveys, no medical school has totally abandoned tenure. Only a few limit it to basic-science faculty. "I think it's really difficult to conclude that tenure is in jeopardy," she says. It's just that tenure, and its role at institutions, is changing.

It is possible, Duke University's Brown says, that these changes may prove more consistent with the values of the incoming generation of researchers, who tend to be less loyal to institutions and more interested in wide-ranging careers and work-life balance. "We have to be thinking about how we train individuals to be flexible," says Joan Lakoski, the associate vice chancellor for academic career development at the University of Pittsburgh Schools of the Health Sciences. Even if young researchers are not thrilled with the shrinking proportion of tenure-track positions, she says, the changing tenure picture provides opportunities for them to take advantage of their unique strengths and form new, unconventional collaborations.

Lakoski presents Wendell, who used to work in her office, as the case in point, and he agrees. "Nobody would get up ever in a workshop and propose the model that worked for me," Wendell says. "Don't be constrained by this traditional pathway."

Author identification: Chelsea Wald is a freelance science writer in New York.